Guest guest Posted May 13, 1999 Report Share Posted May 13, 1999 How can this be? Our SNF is reimbursed 25% on Prospective Payment, and 75% based on our cost report. How could the $1500 cap on therapies possibly apply to our patients? We aren't getting reimbursed for that therapy based on our charges anyway - it's based on the per diem payment for the RUGS, plus our cost report. I thought it only applied to outpatient services. >>> 05/13/99 10:24AM >>> Subject: $1500 CAP & HOSPITALS Author: <ptmanageregroups> Date: 5/12/99 5:43 PM Two questions: 1. If you are from an acute care hospital that houses its own SNF, are the residents subject to the $1500 cap? YES. 2. If a hospital has a contract to provide Rehab service to a nursing home (off campus), are those residents subject to the $1500 cap? IF IT IS A SNF PARTICIPATING IN THE MEDICARE PROGRAM, THEY ARE SUBJECT TO THE CAP. AS FOR OTHER NURSING FACILITIES THAT ARE NON-PARTICIPANTS IN THE MEDICARE PROGRAM (I.E., RCFS, ICFS and SOME SNFS)....I HAVE BEEN TRYING TO SEEK THE ANSWER TO THIS FOR THE LAST 2 MONTHS. I CAN FIND NO REGULATIONS THAT WOULD PRECLUDE YOU FROM OPENING AN OUTPATIENT CLINIC IN A NON-PARTICIPATING FACILITY. HOWEVER, THE ADVICE I KEEP RECEIVING IS TO CONTACT HCFA DIRECTLY AND RECEIVE " IN WRITING " THEIR OPINION ON THIS ISSUE. Lucille Byrne Administrative Director Pathology/Rehabilitation Jeanes Hospital Temple University Health System Philadelphia, Penna. 19111 Good luck, and let me know if you find anything out. Likewise, I will post any information I find out. Kathy Shields SmartRehab St. Louis, Missouri kathy_shields@... ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 1999 Report Share Posted May 13, 1999 The $1500 cap is for outpatient services, Nursing homes are under PPS which is totally different. ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 1999 Report Share Posted May 13, 1999 The $1500 cap would only apply to services provided under Part B, not to Part A patients who are reimbursed based on the RUG's under PPS. Kay ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 1999 Report Share Posted May 13, 1999 Hi Lucille - good to hear from you. The $1,500 cap only refers to Medicare Part B. If an inpatient in a SNF unit exhausts their Part A benefit and must go to Part B then they would be subject to the $1,500. This is because of the consolidated billing requirement of the BBA'97. The same is true if you contract with a SNF. Does this answer your question? If not, just let me know. Thanks. Have a good day. ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 1999 Report Share Posted May 13, 1999 Time to call the question on this one - there has been a substantial amount of misinformation. SNF residents/patients can be Part A Medicare or Part B. Part B SNF residents (even though they are " inpatients) still fall under the $1500 cap. This has been very well documented and referenced by several list members. If you need the regulations to review on this one - www.PTManager.com. We've divided the regs by site of service. We need to stop offering opinions when the discussion calls for FACTS. All opinions are NOT created equal. Please, if the list is discussing concepts, opinions are valid. When the list is asking for facts, only referenced and documented comments are appropriate. We've gotten too lax - let's clean it up. At 09:10 PM 5/13/99 , you wrote: The $1500 cap is for outpatient services, Nursing homes are under PPS which is totally different. R. Kovacek, MSA, PT Email Pkovacek@... 313 884-8920 Visit <www.PTManager.com> TOGETHER WE CAN MAKE A DIFFERENCE ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 1999 Report Share Posted May 24, 1999 : What about a hospital operating a freestanding OP facility? Are thry exempt from the cap? Beth , MHEd, PT, CHT Medical University of South Carolina University Center, Greenville, SC Michele wrote: > " Currently the $1500 cap applies to all therapy services covered by Medicare B with theh exception of an OP facility in an acute care hospital. They are currently exempt. " > > eGroups.com home: /group/ptmanager > - Simplifying group communications ------------------------------------------------------------------------ eGroups.com home: /group/ptmanager - Simplifying group communications Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 1999 Report Share Posted May 24, 1999 Only the outpatient departments that are under the hospital's provider number are exempt from the cap. The rules are changing about provider-based outpatient sites. Some sites that are now classified as provider-based may be re-classified under the new rules when they are final. Kay Consulting, LLC kdd3800@... ------------------------------------------------------------------------ eGroups.com home: /group/ptmanager - Simplifying group communications Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 1999 Report Share Posted May 24, 1999 Kay is absolutely right. The reference on the proposed rules is September 8, 1998 Federal Register. You can access the document at <www.PTManager.com/news.htm>. You will need Adobe Acrobat Reader to view any of the Federal Register documents. You can download Acrobat Reader at <www.Adobe.com> At 07:32 PM 5/24/99 , you wrote: Only the outpatient departments that are under the hospital's provider number are exempt from the cap. The rules are changing about provider-based outpatient sites. Some sites that are now classified as provider-based may be re-classified under the new rules when they are final. Kay Consulting, LLC kdd3800@... eGroups.com home: /group/ptmanager www. - Simplifying group communications R. Kovacek, MSA, PT Email Pkovacek@... 313 884-8920 Visit <www.PTManager.com> TOGETHER WE CAN MAKE A DIFFERENCE ! eGroups.com home: /group/ptmanager www. - Simplifying group communications Quote Link to comment Share on other sites More sharing options...
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